August 30, 2019

Can the Congressional Review Act Be Used for Good?

Icons of Congress and a lightning bolt zapping an agency-issued rule.President Trump has done all he could to turn back and undo much of what a number of his recent predecessors of both parties had put in place. His targets range from the EPA to the ACA. He’s used executive orders, called for legislative actions, and appointed agency heads with views antithetical to an agency’s core purpose. But perhaps most insidious has been the use of regulatory modifications and deletions to undermine and dismantle key federal programs and protections. Continue reading “Can the Congressional Review Act Be Used for Good?”

August 7, 2019

Illinois Says No to Title X Funds, Yes to Fixing Medicaid

Woman carries a pink I Stand with Planned Parenthood sign at May 1, 2017, Chicago march. Photo by Christine Geovanis CC-BY 2.0Last month, the U.S. Department of Health and Human Services notified clinics that it would begin enforcing a ban on abortion referrals “immediately.” The announcement, directed at facilities that receive Title X funds, was quickly followed by one from Planned Parenthood of Illinois, saying it will turn down Title X funds going forward. “Our doors are open,” said Julie Lynn, the organization’s external affairs manager, at a news conference, “and we’re here for our patients.”

The move was followed up the same week by a statement from Gov. Pritzker that the state would step in to fund most of those clinics itself. Continue reading “Illinois Says No to Title X Funds, Yes to Fixing Medicaid”

July 11, 2019

Beach Reads, Pods, and Healthcare Costs

An Arm and a Leg show - a podcast about the cost of healthcareIt’s summer at last. Time to read a good book, and catch up on some podcasts. Here’s one we like – it’s about the cost of healthcare. How much does healthcare cost in the U.S.? An Arm and a Leg, started in November by former WBEZ reporter Dan Weissmann, explores that. “Entertaining, empowering, and even useful” – rather than political – it’s about “the way that healthcare runs our lives.”

“The minute I started telling people I was thinking of doing this show,” Dan says in the first episode, “everyone had a story of their own.” They can be pretty riveting. Continue reading “Beach Reads, Pods, and Healthcare Costs”

June 11, 2019

A Medicaid Reform that Passed Unanimously

Moher holding her baby, sitting on floor in front of couchIt’s hard to believe, but true – the omnibus Medicaid reform bill headed to Gov. Pritzker was passed without a single dissenting vote in either of Illinois’ famously disputatious legislative chambers.

It might be because the need for change was so unambiguously clear: the difficulty people had enrolling and in the program, the vast backlog of applications, the likelihood of losing your coverage in the course of the renewal – or “redetermination” – process, and growing frequency of claims denials. It also represents many months of negotiation and compromise by all parties. Continue reading “A Medicaid Reform that Passed Unanimously”

May 2, 2019

Rate Review – What a Difference!

Logo of Illinois Depart of Insurance with Department of Prior Approval labelOn April 11, the Freedom from Aggressive Insurance Increases Review Act passed the Illinois House on a bipartisan 73-41 vote. The bill ( HB 471 ), known as the FAIIR Act, would give the Department of Insurance the authority to approve or deny unreasonable health insurance rates. This kind of meaningful rate review is practiced in 37 states and has been shown to curb outrageous rate hikes.

In terms of health insurance, Illinois is what is known as a “file and use” state, which means that insurance companies must file their intended premium rates, which then go into effect without having to be approved by the Department of Insurance. In “prior approval” states, the insurance commissioner can approve, reject, or reduce rates, often actively negotiating with the insurer. Continue reading “Rate Review – What a Difference!”

April 9, 2019

Rules May Complicate Pritzker Plan to Tax MCOs

Cover of Illinois FY 2020 budget proposal, with photo looking up into capitol doneGov. Pritzker’s budget proposal delivered last month calls for new taxes on cigarettes and insurance companies to fund Medicaid. Here is some context on where it came from and the challenges it faces.

The Department of Healthcare and Family Services operating budget of $25.1 billion is about $900 million more than for the current year. The vast majority of it is earmarked for Medicaid. The program, which covers 1 in 4 Illinois residents, accounts for close to a third of total state spending. Continue reading “Rules May Complicate Pritzker Plan to Tax MCOs”

March 13, 2019

Will Benefits Updates Follow Wage Increase?

For every dollar the boss had and didn't work for, one of us worked for a dollar and didn't get it - Women's March signThe long fought-for $15 minimum wage bill was signed into law by Governor Pritzker on February 19. It raises the state’s minimum hourly wage from $8.25 to $9.25 next year, and then phases it in to $15 by 2025.

Although the federal minimum wage is still $7.25, much of the country has moved on. More than 60% of the working age population is estimated to live in areas with a higher-than-federal minimum. Chicago and Cook County have raised theirs, currently at $12 and $11, respectively. California, Massachusetts, and New Jersey will beat us to $15. As of January 2017, 29 states and a couple dozen cities had set their own minimum wage, and a dozen states automatically raise it every year to keep pace with inflation. Continue reading “Will Benefits Updates Follow Wage Increase?”

February 13, 2019

Imagine Medicaid with Informed Consumer Choice

Patient getting in-person assistanceDo you remember when the ACA Marketplace opened in 2013, and the whole thing was so complicated that special roles like “navigators” and in-person counselors, aka IPCs, had to be created to help people enroll? Even though few assisters remain due to significant funding cuts from the federal government, people still need help with healthcare choices, especially in our Medicaid program.

Most people have access to expert help figuring out their healthcare choices. With an employer, you have an HR person or representative to help you sort through your healthcare choices. On the private market, you have brokers and agents. In Medicare, you have Senior Health Insurance Program counselors and brokers. Granted, all those systems have their shortfalls, but the common thread is that there is a person you can reach for help.

Not so for Medicaid recipients – the people likely to need it the most. Continue reading “Imagine Medicaid with Informed Consumer Choice”

January 16, 2019

Medicare In-home Services: Learn from Medicaid

A senior holds her glasses and handbag. New services may help more seniors stay at home.

As people age, they typically need more help doing everyday things, whether it’s getting the groceries or taking a shower or remembering to take their meds. In many cases, even limited assistance can allow a senior to remain in their home for many years, even decades.

The logical program to provide in-home services is Medicare, which pays for most of seniors’ medical care. But Medicare does not cover them. Medicare does cover skilled medical services like physical therapy or nursing care when you’re ill or recovering from an illness or surgery, but you must be certified by a doctor as homebound, and even then it will not cover non-medical home services such as help bathing or dressing or preventive aids such as grab bars. The result is that many seniors end up spending down their resources to be eligible for Medicaid to get the non-medical care they need in order to live at home. Our system makes middle class people become poor to get the care they need – and, ultimately, states pick up the tab. Medicaid has been covering a growing portion of long-term care in the U.S. – 53% in 2018.

But 2019 ushers in help at home services for Medicare – and the change may be the catalyst for a more dramatic transformation in healthcare delivery and effectiveness.

Continue reading “Medicare In-home Services: Learn from Medicaid”

December 14, 2018

Will 2019 Bring a Medicaid Buy-in to Illinois?

Map of states exploring Medicaid buy-in, updated from
Click to enlarge
When Governor-elect JB Pritzker and incoming legislators take office a few days from now, we hope among the top-of-mind issues for them will be healthcare – and the possibility of creating a public option that would allow Illinois residents to purchase a premium to participate in the state’s Medicaid program. Candidate JB Pritzker talked about his vision for such an initiative, which he called “IllinoisCares,” and his platform included a public health insurance option that would be available to all residents.

IllinoisCares would allow Illinois residents to purchase health insurance from the state, rather than a commercial plan. Forty-two states – including Illinois – already have Medicaid buy-in programs, but they are limited to working people with disabilities who have not been able to purchase affordable health insurance coverage that meets their health needs in the private market. Continue reading “Will 2019 Bring a Medicaid Buy-in to Illinois?”

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